CLINICAL AND SURGICAL CONSIDERATIONS ASSOCIATED WITH CARDIOVASCULAR RISK IN PATIENTS WITH PREVIOUS AMI

Abstract

Introduction: Acute Myocardial Infarction (AMI) is a critical medical condition and one of the main causes of global mortality. Patients who have suffered a previous AMI face a significantly elevated cardiovascular risk, requiring rigorous clinical and surgical management to prevent new cardiovascular events. The management of these patients includes optimizing risk factors, such as hypertension, diabetes and dyslipidemia, in addition to adherence to medications such as angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, statins and antiplatelets. Surgical interventions, such as myocardial revascularization, are often necessary, depending on the extent of coronary disease and the patient's clinical condition. Objective: To evaluate the clinical and surgical considerations associated with cardiovascular risk in patients with previous AMI, providing a comprehensive overview of the most effective management strategies. Methodology: The methodology of this review was based on the PRISMA checklist, using the PubMed, Scielo and Web of Science databases. The descriptors used were "myocardial infarction", "cardiovascular risk", "myocardial revascularization", "post-infarction medication" and "secondary prevention". Articles published in the last 10 years, written in English or Portuguese, that addressed clinical or surgical interventions in patients with previous AMI were included. Inclusion criteria included randomized controlled trials, prospective cohorts, and systematic reviews. Exclusion criteria involved opinion articles, studies with fewer than 50 participants and research carried out outside the hospital context. Results: The results of this review indicated that strict clinical management, including the use of statins, ACE inhibitors and beta-blockers, significantly reduced mortality and recurrence of cardiovascular events. Surgical interventions have shown clear benefits in patients with multiple coronary lesions and left ventricular dysfunction. However, the choice between angioplasty and CABG must be individualized, considering the coronary anatomy and the patient's general condition. Conclusion: Adherence to medication treatment, lifestyle modification and careful selection of surgical interventions are crucial to minimize cardiovascular risk and improve the quality of life of these patients. Continuous monitoring and periodic assessments are essential to adjust treatment according to clinical evolution, highlighting the importance of a personalized and comprehensive approach in the secondary prevention of cardiac events.